FTP3.12 Can pre-operative MRI predict the extent of surgery in Deep Infiltrating Endometriosis – An Observational Study

Abstract

Abstract Aims Deep Infiltrating Endometriosis (DIE) surgery is complex & the interventions involving multi-specialties can be unpredictable. Frequently it depends on the extent of the bowel/bladder involvement. We aim to study the role of MRI in predicting such involvement & in pre-operative multidisciplinary planning of DIE surgery. Methods All consecutive patients between Jan 2021 & Dec 2022 who underwent MRI scan & subsequent DIE surgery in an accredited endometriosis center were included. Correlation was studied especially with reference to the bowel/bladder involvement between MRI findings & operative interventions. Results A total of 19 patients were included. Mean age of the patients was 41.83 years (range 27-55 years). Five out of 19 (26%) & 2 of 19 (10%) patients showed measurable (length & depth) endometrial deposits rather than adhesions/endometrial scarring on MRI in bowel (rectum &/or sigmoid) & bladder wall respectively. Two patients had anterior resection and primary anastomosis and 6 had either shaving or disc excision of the bowel wall. Both patients with bladder wall involvement required full thickness resection of bladder wall. The sensitivity, specificity and positive & negative predictive values of MRI depicting the extent of bowel and bladder intervention were 71%, 90%, 90% & 69% respectively. Conclusion MRI helps predict the extent of DIE surgery & facilitates pre-operative planning of multi-specialty approach. Specific volume categorization of the measurable deposits may influence the nature of bowel/bladder surgery (resection vs shaving). A large scale multicenter prospective study would be useful for further evaluation.